Radical operation with extensive dissection of lymph nodes (R1, 48 patients; R2, 196 patients; R3, one patient) was performed in 245 out of 247 patients with early gastric cancer. The 5-year survival rate was only 73.2 per cent in the 34 patients with lymph node metastases (31.8 per cent). Analysis of factors influencing recurrence revealed that not only lymph node metastases but also the depth of cancer invasion could affect prognosis in early gastric cancer. This study suggests that radical operation with complete dissection of the first and second group of lymph nodes (R2 resection) is a safe and appropriate treatment even for early gastric cancer. We propose that the definition of early gastric cancer be modified to 'carcinoma with invasion confined to the mucosa or submucosa and without evidence of lymph node metastases'.

A 31-year-old Japanese woman with Glanzmann's thrombasthenia became pregnant voluntarily. She had had transfusions with more than 60 units for severe bleeding. She had multiple antibodies against HLA antigens and platelet glycoprotein IIb/IIIa. No compatible platelets were available. To prevent serious hemorrhage during her delivery, antibody removal therapy was carried out three times. Large molecules including immunoglobulins were removed from more than 3 liters of plasma each time. After the titer of antiplatelet antibodies had decreased in the patient's blood, antihuman globulin-lymphocyte cytotoxicity test compatible platelets were transfused. Her bleeding time improved and delivery was induced successfully despite atonic hemorrhage of about 2,000 g of blood. Her infant had no bleeding problems. This patient is the first with Glanzmann's thrombasthenia to receive antibody removal therapy at delivery.

SummarySubnormal platelet responses to thromboxane A2 (TXA2) were found in a patient with polycythemia vera, and the mechanism of this dysfunction was analyzed. The patient’s platelets showed defective aggregation and release reaction to arachidonic acid, enzymatically generated TXA2 and synthetic TXA2 mimetics (STA2, U-46619). In contrast, they showed normal responses to thrombin. When the platelet TXA2 receptor was examined with both a 125I-labelled derivative of a TXA2 receptor antagonist ([125I]-PTA-OH) and a 3H-labelled TXA2 agonist ([3H]U-46619), the equilibrium dissociation rate constants (Kd) and the maximal concentrations of binding sites (Bmax) of the patient’s platelets to both ligands were within normal ranges, suggesting that the binding capacity of their TXA2 receptor was normal. STA2 failed to induce normal elevation in the. cytoplasmic free calcium ion concentration, phosphatidic acid formation and 40 kD protein phosphorylation in the patient’s platelets, whereas these responses to thrombin were within normal ranges. 12-O-Tetradecanoyl-phorbol-13-acetate (TPA) also evoked normal response in the 40 kD protein phosphorylation in the patient’s platelets. These results suggested that the patient’s platelets had TXA2 receptor abnormalities which were characterized by defective transduction of the binding signal to postreceptor reactions after normal TXA2 binding.

A 31-year-old Japanese woman with Glanzmann’s thrombasthenia became pregnant voluntarily. She had had transfusions with more than 60 units for severe bleeding. She had multiple antibodies against HLA antigens and platelet glycoprotein IIb/IIIa. No compatible platelets were available. To prevent serious hemorrhage during her delivery, antibody removal therapy was carried out three times. Large molecules including immunoglobulins were removed from more than 3 liters of plasma each time. After the titer of antiplatelet antibodies had decreased in the patient’s blood, antihuman globulin-lymphocyte cytotoxicity test compatible platelets were transfused. Her bleeding time improved and delivery was induced successfully despite atonic hemorrhage of about 2,000 g of blood. Her infant had no bleeding problems. This patient is the first with Glanzmann’s thrombasthenia to receive antibody removal therapy at delivery.

No abstract